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Surgery No Longer Last Resort for Trigeminal Neuralgia

Surgery may be a better option for individuals with trigeminal neuralgia than second-line drugs, according to new American Academy of Neurology guidelines.

Trigeminal neuralgia (also known as tic douloureux) generally strikes people over age 50. The pain is an intense, burning sensation on one side of the face, often set off by touch, chewing, laughing, talking or even a cold breeze. The intermittent jabs of pain last for approximately 30 seconds, followed by a few pain-free moments, and then another group of painful jabs, which may reoccur for a few hours at a time. The attacks can go on for weeks or months.

Typically, trigeminal neuralgia is treated with either carbamazepine or oxcarbazepine. However, in those cases where these drugs don’t help, surgery to target the root of the trigeminal nerve may be more useful than trying less effective, second-line medications. The academy did not say which surgical intervention is the most effective, however, because of a lack of comparative studies.

The academy collaborated with the European Federation of Neurological Societies to review the evidence for diagnostic and therapeutic strategies in both forms of trigeminal neuralgia: classic (no known cause) and symptomatic (caused by a structural abnormality such as tumors or plaques). As well as making the surgical recommendation, the academy recommended head imaging and trigeminal reflex testing if symptomatic trigeminal neuralgia is suspected.

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